Knowledge is Healing

But the four-physician practice, feeling financially drained by transcription costs running $9,000 per month, plunged ahead with a $200,000 investment. Ten years later, it has no regrets.

"People say we were early adopters, and I guess that's true," Dr. Morrow said. "But at the time we were just trying to survive."

The theme of survival is common among practices that decided the gamble of implementing an EMR was less frightening than continuing in their current situations.

Sometimes the gamble fails: Partners are resistant to using the system; employees aren't well-trained in it; the system itself fails to meet a practice's needs. This can result in a junked EMR and a lost investment.

But sometimes the gamble succeeds. Here, four physicians tell how they decided -- despite well-documented evidence of everything that could go wrong -- that an EMR was right for them, and how they succeeded in getting a return of their financial investment within the first year of operation.

Saving her practice
Solo family practice in Texas
8 months to recoup costs

In 2006, after five years in a shared family practice that serves mostly indigent, Medicaid and Medicare patients, Alicia V. Valdez, MD, of the South San Antonio Family Practice found herself facing life as a solo physician.

A bill on the desk of Gov. Bill Ritter Jr. would require plans to disclose data and methodology in reaching physician grades and tiering, a process by which insurers group physicians based on purported quality, then offer a discount to members who only see doctors in the highest-rated tier.

The Colorado bill also spells out standards for data and how they are used, as well as asking for transparency. It says plans must use risk-adjusted data, and base grades and ratings at least in part on nationally recognized quality-of-care measures and not on cost alone. Physicians would have the right to review and appeal their ratings.

"Physicians their whole life have been graded," said Colorado Medical Society President-elect W. Ben Vernon, MD, a Denver transplant surgeon. "Getting stars is what doctors in our country are all about. We just would like those stars to be given in a way that makes sense and is correct."

The Colorado bill was based on discussions by the Physicians Advisory Council to UnitedHealthcare. The council was established by the state insurance commissioner as a condition of the United-PacifiCare merger in 2005, said CMS President David Downs, MD, an internist in Denver.

Baby boomers, by virtue of their age, are more likely to have a "few chinks in their armor" that make them seem riskier to insure, said Jude Thompson, senior vice president for Indianapolis-based WellPoint and president of Anthem BlueCross BlueShield's individual business.

But despite their age, Thompson said, the group actually is the most profitable demographic among those who buy individual policies -- and perhaps more important, they have the potential to be valuable customers for the rest of their lives.

Whichever company they choose already has a leg up in the very competitive market for Medicare Advantage products.

To win their loyalty, insurers aren't waiting for boomers to turn 65 and become eligible for Medicare. They believe it's better to start now by capturing the attention of early retirees, business owners and others who need to buy their insurance directly.

"The competition for the senior today is greater than it's ever been," Thompson said.

Health insurance in general is a "sticky" product, meaning consumers are prone to keep the status quo, and Medicare Advantage has a retention rate "north of 90%," said David McNichols, general manager of individual Medicare products for Cigna.

At least so far, boomers are brand loyal, WellPoint's Thompson said.

The health care organization and drugstore chain in April announced an agreement to open four physician-operated retail-based health clinics in the Baltimore and Washington, D.C., areas this summer. The walk-in clinics, to be called MedStar PromptCare, will be housed inside Rite Aid drugstores, staffed by MedStar-affiliated physicians and managed by Consumer Health Services Inc., a third partner in the agreement.

The clinics will be "a step above a nurse practitioner-run clinic and right below an urgent care clinic," said Erika Murray, spokeswoman for MedStar Health, a network of eight hospitals and other health care services.

While clinics staffed by nurse practitioners are limited to treating colds and other minor ailments, MedStar physicians will also treat minor injuries, such as sprains and minor laceration repair, said Sean O'Donnell, a spokesman for New York-based CHS.

MedStar Health said it will ensure access to follow-up medical services for the clinics. It said the clinics' physicians will be credentialed by and have admitting privileges to MedStar hospitals.

Murray said this is MedStar Health's first initiative in the retail clinic business. She said the clinics should strengthen the health care organization's ties with its physicians.

Walgreens announced in March it is purchasing Chadds Ford, Pa-based I-trax Inc., and Cleveland-based Whole Health Management, which have a combined total of 369 of the estimated 7,600 work-site clinics across the country.

The drugstore chain said the acquisitions are part of its strategic plan to launch a health and wellness division that will also include Take Care Health Clinics, the store-based retail clinics located inside Walgreens stores. The company plans to connect its work-site clinics, store-based clinics and its pharmacy business into a single, integrated electronic system.

The work-site clinics, usually located at companies that are self-insured, offer services ranging from fitness centers to work-site pharmacies. In some cases, they offer primary care. The level of service is determined by each employer who contracts with the clinic operators.

According to Watson Wyatt, an Arlington, Va.-based consulting firm, nearly one-third of companies have or plan to have work-site clinics in 2009, up from 27% in 2006.

Because the Walgreens deal has not yet closed, the companies said they are not able to discuss expansion plans. But CHD Meridian Executive Vice President and Chief Operating Officer Peter Hotz said his company had its own expansion plans in the works before Walgreens entered the picture. CHD Meridian is the I-trax subsidiary that operates work-site clinics. Another subsidiary, ProFitness Solutions, provides wellness services.

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